Non-payable items in health insurance, the IRDAI list in plain words

Where the list comes from

The list known as "IRDAI non payable items" is Annexure I of the Master Circular on Standardization of Health Insurance Products, reference IRDAI/HLT/REG/CIR/193/07/2020, dated 22 July 2020. Its title is "Items for which optional cover may be offered by Insurers". You can read it on the IRDAI website, on pages 26 to 31 of the circular.

The annexure has four lists. Only List I covers items the policy may leave out altogether. Lists II, III and IV cover items that a hospital should fold into a bigger charge instead of billing them one by one.

Policy wordings can reprint these lists as an annexure. The standard Arogya Sanjeevani wording in the same 2020 circular calls it Annexure A. Search your policy for "List I" to find it.

Items on the IRDAI lists146List I, optional items68 List II, part of the room charge37 List III, part of the procedure charge23 List IV, part of the cost of treatment18

List I, optional items (68 items)

These are items your policy does not have to pay. An insurer may still choose to cover some or all of them, or sell an add-on for them. In plain words, List I includes:

Personal care and comfort
- baby food
- beauty services
- toiletries
- creams and powders
- sanitary pads
- diapers
Services for the family
- attendant charges
- guest services
- extra food
- laundry
Phone, internet and television charges
Paperwork
- certificates
- medical records
- photocopies
- courier
- the birth certificate
Supports and home-use devices
- belts
- braces
- collars
- slings
- walking aids
- thermometers
- steam inhalers
- nebuliser kits
Some ward items
- gloves
- ECG electrodes
- kidney trays
- kits sold without details
Private nurses, mortuary charges, and ambulance charges and equipment

Some policies pay road ambulance as a stated benefit even though it sits on List I. The 2020 Arogya Sanjeevani wording, for example, covers road ambulance up to ₹2,000 per hospitalisation. Your policy wording decides.

List II, part of the room charge (37 items)

These belong inside the daily room charge. Examples are gowns, slippers, toothpaste, tissue paper, bed pans, housekeeping, air conditioning, the admission kit, documentation and admin charges, discharge procedure charges, file opening charges, visitor passes, patient ID bands and "miscellaneous charges" with no explanation.

List III, part of the procedure charge (23 items)

These belong inside the charge for the surgery or procedure. Examples are gauze, cotton, surgical tape, razors for site preparation, surgical blades and drills, drapes, eye kits, X-ray film, instruments used for arthroscopy and endoscopy, and ward or theatre booking charges.

List IV, part of the cost of treatment (18 items)

These belong inside the treatment charge. Examples are admission or registration charges, urine bags and containers, infusion pump cost, BiPAP and CPAP equipment, dietician charges, vaccination charges, glucometer and strips, spirit and swabs, and a stay taken only for evaluation or tests.

What IRDAI told insurers about Lists II to IV

The 2020 circular said insurers must make sure hospitals do not bill these items to the policyholder. It asked insurers to put this into their service agreements with network hospitals for cashless cases. For reimbursement claims at other hospitals, the insurer settles as per the policy terms.

Where the rule stands now

IRDAI's Master Circular on Health Insurance Business of 29 May 2024 lists the July 2020 standardisation circular as item 1 of the 55 circulars it supersedes. We found no new list in the 2024 master circulars. Policies written to the 2020 circular still carry the four lists in their own wording, and that wording is your contract. Read the version attached to your own policy, because your insurer may cover more than the minimum.

How to check your bill

Ask the hospital for an itemised final bill.
Find the annexure in your policy wording.
Mark each line that matches List I. These you will usually pay yourself unless your policy covers them.
Look for lines that match Lists II, III or IV. At a network hospital, ask the insurance desk or TPA why they were billed separately.
Keep the settlement letter. If the insurer disallowed an item, the reason must cite a policy clause.

Have a hospital stay coming up? Send your policy on WhatsApp and a person checks it for you.

Questions

What are non-payable items in health insurance?

They are hospital charges your policy does not pay, such as toiletries, phone and laundry charges, attendant charges and many paperwork fees. IRDAI grouped them into four lists in Annexure I of its July 2020 standardisation master circular.

Where is the IRDAI list of non-payable items?

It is Annexure I, titled Items for which optional cover may be offered by Insurers, in the Master Circular on Standardization of Health Insurance Products dated 22 July 2020. Your policy wording may reprint it as an annexure.

Is the admission kit charge payable?

IRDAI placed the admission kit in List II, the items that belong inside the room charge. At a network hospital it should not appear as a separate line, and insurers were told to write this into their hospital agreements.

Can my policy pay for items on List I?

Yes. The 2020 circular let insurers cover some or all List I items, or sell add-on covers for them. Check your policy wording and any add-ons you bought.